Ch 14 Nutrition for Childbearing

Ch 14 Nutrition for Childbearing


Ch 14 Nutrition for Childbearing
I talked about recommended weight gain earlier. The amount goes by pre-pregnancy BMI. Table 14.1 breaks this down for you. This is very individualized and the provider
will discuss it with the patient. The pattern of weight gain is just as important
as the amount. Approx 1.1-4.4 pounds should be gained in
the first trimester. This is the time when many women may be nauseated
and the fetus needs fewer nutrients. For the rest of the pregnancy normal weight
gain should be 0.8-1lb per week. Once again, this is for the woman with the
normal pre-pregnancy BMI. An increase in nutrients is needed during
pregnancy to meet the demands of the mother and the fetus. No added calories are needed in the first
trimester, an additional 340 calories is needed during the second trimester and an additional
452 calories in the 3rd trimester. I am just going to touch on a few of the more
important nutrients during pregnancy. Folic acid can decrease the occurrence of
neural tube defects such as spina bifida, anacephaly and could also reduce the risk
of cleft lip and palate and some heart defects. The intake is important before conception. Healthy People 2020 guidelines include all
childbearing aged women take in at least 400 mcg of folic acid each day. The new recommendations are 400-800 mcg daily. This amount should be taken at least 1 month
before conception and at least 2-3 months after conception. An increase in iron is needed for the increase
in maternal red blood cells during pregnancy. The infant will take the needed iron from
the mom so it is important she has adequate intake. Many women do not get enough for many are
placed on iron supplements. Table 14.4 lists foods high in iron. It is a good idea to know which foods are
high in iron. You will be expected to educate on this in
clinical and you may see it on a quiz or test! Calcium is transferred to the fetus especially
during the last trimester. Mom can basically store calcium until it is
needed by the fetus. The needs are not changed during pregnancy
or lactation. Dairy is the best source of calcium. Box 14.1 lists alternative calcium enriched
foods besides milk. Sodium needs increase during pregnancy due
to the expanded blood volume and the needs of the fetus. Sodium doesn’t need to be restricted during
pregnancy but high sodium foods should be limited. This are listed in box 14.2. Many women are prescribed prenatal vitamins
during pregnancy. Adequate nutrients besides folic acid and
iron can be obtained from the diet and that is the preferred method to obtain the nutrients. Water is very important during pregnancy due
to the increased blood volume and as part of the maternal and fetal tissues. Pregnant woman should consume 8-10 cups of
fluid a day with the majority of that being water. Water is also important to prevent dehydration
which can cause preterm labor. There are certain foods that should be avoided
during pregnancy. One of these foods is large fish as they may
contain high levels of mercury which can damage the nervous system of the fetus. Small fish typically have smaller amounts
of mercury and are ok to eat. Raw fish should be avoided due to the possibility
of parasites and bacteria. Certain foods can contain listeria and can
cause abortion, premature labor, infant death or severe illness in the infant. Foods that may contain listeria include luncheon
meats and hot dogs. Others include soft cheeses, unpasteurized
milk or milk products or undercooked meats or poultry. Eggs need to be fully cooked to be consumed
during pregnancy as well. Toxoplasmosis can be contracted if a pregnant
woman eats raw meat, unwashed fruits or vegetables and it can be contracted from cat feces so
a pregnant woman should not empty or clean liter boxes. There are factors that influence nutrition. One of course is age. The adolescent needs nutritional support for
her own body but then needs more for the fetus. As a nurse, one of the first things we do
before we educate, is to find out their knowledge regarding nutrition. I have worked many community events where
I would educate on nutrition and certain foods to avoid or to have to meet their needs and
it amazes me how many people really do not know what is healthy. If you ask them if they know what a healthy
diet is, they may say yes when they really don’t know. It is better to ask them tell me what a typical
day looks for you food wise. So many people think salads are healthy. They can be but if they are putting bacon,
cheese and a ton of dressing, they are not so healthy. Always find out their knowledge level first. Exercise can influence nutrition as well. Moderate amount of daily exercise is recommended
in a non-complicated pregnancy. If they exercise more strenuously, they will
additional calories and nutrients so assess their exercise habits. Culture is a big factor as well. You must assess if they understand or can
read English. Some cultures believe foods are either “hot”
or “cold” and this must balance. Getting a basis of their beliefs can help
us determine correct guidelines for them. There are of course some risk factors associated
with nutritional deficits. Socioeconomic is a big risk factor. Many do not have the financial means for good
nutrition. There are programs that can help. WIC (Women, Infants and Children) is an excellent
program that helps the pregnant woman get healthy foods. You must financially qualify for these programs
and many times they are carried on to postpartum and for needs for the infants. If an infant has certain health conditions,
they can qualify for WIC even if they do not qualify financially. Providing the pregnant moms with info for
WIC is they do not already have is a good thing to do. We already talked about the adolescence and
nutrition. Many times they still require extra nutrients
or they just have poor eating habits so education needs to be provided to them. One issues the adolescence can have is body
image. They may not want to gain too much so they
won’t have much to lose after baby is born. Helping them come up with a well balanced
diet is something we need to do. Remember, you must assess what types of foods
any person likes before we provide education. We all know someone who hates vegetables. Telling them to eat 4 servings a day is probably
not going to happen. Coming up with a plan of other foods that
contain those same nutrients can help. Vegetarianism can be a problem during pregnancy
for some women. They need to find alternatives to the foods
they do not eat so they are still getting a well-balanced diet. They may need supplements during pregnancy
to ensure they are getting all the recommended requirements. Encourage a woman experiencing pregnancy nausea
and vomiting to eat 6 small meals a day. Try to avoid fried foods. Typically proteins and complex carbs are better
tolerated. Eating crackers or dry toast before getting
out of bed may help. Also drinking liquids between meals instead
of with meals can help some women as well. We talked somewhat about anemia earlier. Many pregnant women will experience anemia
during pregnancy as the fetus needs the iron and the extra blood volume being diluted. Encouraging those foods high in iron is good
and if she is prescribed iron supplements, encourage compliance with this as well. Some women can have abnormal pregnancy weight. Ruling out eating disorders is something that
needs to be done. Woman can suffer from anorexia nervosa or
bulimia. Many women will have food cravings or food
eversions during pregnancy. There is no known cause why woman experience
them but it could be from their change of taste and smell during pregnancy. These typically are non-harmful. Pica is eating nonfood or some food components
not considered part of a normal diet. Examples can be ice, dirt, laundry soap, paper,
coffee grounds or numerous other things. The cause is not known but sometimes can be
related back to an iron deficiency. Many of these can be harmful and need to be
addressed with the provider. Women who have had a child before are at a
higher risk of starting this next pregnancy with some nutritional deficits. A woman who is multifetal will need to gain
more weight and need additional nutrients. IF not met by her diet, supplements may be
needed. Many times substance abuse follows an unhealthy
lifestyle. Many times it is due to no money left for
food or the substance they use decreases their need to feel they need to eat. A few substances we need to be aware of are
smoking (nicotine), caffeine, alcohol and drugs. Nicotine increase metabolic rate and decreases
appetite. More research is needed regarding caffeine. Small amounts seem to not have any negative
effect. Alcohol can cause alcohol fetal syndrome for
the infant so at this point, all alcohol should be avoided. Many drugs cause harm to mom and fetus so
discourage any drug use. Many can be appetite suppressants and cause
nutritional deficits as well. For woman who are breastfeeding after birth
they will need an additional 330 calories the first six months and then need an extra
400 calories for the next six months. A reminder to new moms it should be a well
balanced diet and to discourage dieting without assistance from their provider or nutritionist
to ensure she is getting adequate nutrition for herself and the baby. Most women will burn more calories while breastfeeding
than those who do not breastfeed so for most woman who are breastfeeding, they can follow
that healthy well balanced meal plan and once ok’d from provider, start exercising and
she will see the extra weight come off. Both lactating and nonlactating moms should
be sure to include vit C and protein in their diet to promote healing. The nonlactating mom can return to her pre-pregnancy
diet after birth. Once again, the best weight loss results are
going to include a well-balanced diet along with exercise once that is allowed.

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